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Use lowest NSAID dose in kidney disease, GPs told

GPs should prescribe the ‘lowest effective dose’ of NSAIDs in patients with chronic kidney disease stage three or above as the drugs are associated with increased progression of the disease, say UK researchers.

The study

NSAIDs are considered a risk factor for CKD, and researchers at Keele University systematically reviewed and analysed three studies to determine the association between NSAID use and CKD progression. They looked at studies involving 54,663 patients with at least stage three CKD and lasting six months or more.

The findings

NSAID use was associated with a non-significant 4% increase in the likelihood of accelerated CKD progression - defined as eGFR decline more than or equal to 15 ml/min/1.73m2 - compared with patients not on NSAIDs. Regular NSAID use was associated with a 4% decrease in the risk of accelerated CKD progression, compared with non-users. But high-dose NSAID use significantly increased the risk of accelerated CKD progression by 26%, compared with non-users.

What does it mean for GPs?

The authors concluded: ‘As the definition of high-dose use is unclear [in the studies] and the fact that NSAIDs have other detrimental effects on kidney function, such as acute kidney injury, they should always be used with caution and given at the lowest effective dose.’

Family Practice 2013, available online 8 January

Readers' comments (1)

  • i would check u/e in all patients on long term nsaid evvery 6 months.never put them on repeats script so every time you do acute rx it reminds you .
    avoid using it in hypertensive patients.i know one patient who was on ace and was given nsaid . he developed acute renal failure within 3 days.

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